Table 2.

Intervention studies of HSU (n=11)

Study	Design	Data source	Participants				Quality		HSU outcomes	Intervention	Control	Reduced HSU? (p<0.05)
			Composition	N	Age	Per cent f	ST	NC
Amner43	Cohort	NHS service data	Patients with BPD availing of DBT	21	36.2 (SD=10.87)	81	13	–	▸ Day care attendances ▸ DBT attendances ▸ Inpatient days ▸ Nurse contacts ▸ Outpatient attendances ▸ PCT attendances ▸ Total HSU	DBT	–	NO
Ballard et al44	Quasi- experi-mental	Care facilities	Patients with dementia	224	82.5 (SD=7.1)	75	12	–	▸ GP contacts ▸ Inpatient days	Psychiatric liaison	Usual care	YES
Bateman45	RCT	NHS PD PCT unit	Patients with BPD	41	31.8 (SD=6.23)	58	–	2	▸ A&E attendances ▸ Outreach worker contacts ▸ Inpatient days ▸ Medication usage ▸ PCT attendances ▸ Psychiatric treatment days	Mentalisation-based treatment by partial hospitalisation	Usual care	YES
Comman-der et al46	Cohort	Assertive outreach service data	Outreach patients with schizophrenia, bipolar disorder or ‘other’ disorder	250	18–64 (M not stated)	26	12	–	▸ Compulsory admissions ▸ Inpatient admissions ▸ Inpatient days	Community outreach service use	–	YES
de Lusignan et al47	Cohort	NHS (IAPT and hospital service) data	IAPT attendees	1118	35.3 (SD=21.4)	50	15	–	▸ A&E attendances ▸ Inpatient admissions ▸ Inpatient days ▸ Medication usage ▸ Outpatient attendances ▸ Sick notes issued	IAPT service	–	YES
de Lusignan et al48	Case control	NHS (IAPT and hospital service) data	IAPT attendees with long-term health conditions	1341	52.8 (SD=11.15)	65	19	–	▸ A&E attendances ▸ Inpatient admissions ▸ Inpatient days ▸ Medication usage ▸ Outpatient attendances ▸ Sick notes issued	IAPT service	–	YES
Hayhurst et al49	Cohort	NHS University hospitals service data	Patients receiving antipsychotic medication	126	42.55 (SD=12.29)	35	16	–	▸ Inpatient admissions ▸ Inpatient days	Clozapine	–	YES
Lam et al50	RCT	Maudsley & Bethlem NHS trust area	Patients with bipolar disorder	87	43.95 (SD=11.45)	33	–	4	▸ Any community services attendance ▸ Medication usage ▸ Non-psychiatric inpatient days ▸ Psychiatric inpatient days ▸ Total HSU	Cognitive therapy (added to usual care)	Usual care	NO
Shi et al51	Cohort	NHS primary care database	Depressed adults initiating duloxetine	909	49.6 (SD=16.5)	67	17	–	▸ A&E attendances ▸ Inpatient admissions ▸ Medication usage ▸ Referrals to specialists	Duloxetine	–	YES
Wade et al52	Cohort	NHS primary care database	Depressed adults using escitalopram, venlafaxine, or generic SSRI	2485	43.1 (SD=14.7)	60	18	–	▸ GP phone calls ▸ GP visits ▸ Inpatient admissions ▸ Medication usage ▸ Referrals to other specialist ▸ Referrals to psychiatrist ▸ Total HSU	Escitalopram	Generic SSRIs; venla-faxine	YES
Woods et al53	RCT	Community-based RCT	Patients of NHS memory clinics and CMHTs	488	77.1 (SD=7.3)	50	–	4	▸ A&E attendances ▸ Care attendant contacts ▸ Care manager contacts ▸ Chiropodist contacts ▸ CMHT contacts ▸ Community psychiatrist contacts ▸ Continuing care/respite contacts ▸ Counsellor contacts ▸ Day hospital contacts ▸ Dietician contacts ▸ Family support worker contacts ▸ GP contacts ▸ Health visitor contacts ▸ Home carer visits ▸ Informal/ voluntary care contacts ▸ Inpatient rehabilitation contacts ▸ General medical ward attendances ▸ NHS contacts ▸ Occupational therapist contacts ▸ Other inpatient ward contacts ▸ Outpatient attendances ▸ Physiotherapist contacts ▸ Nurse contacts ▸ Psychologist contacts ▸ Sitting scheme worker contacts	Reminiscence group	Usual care	NO

A&E, accident and emergency; Age, mean age (if not stated, where possible, age range is stated); BPD, borderline personality disorder; CMHT, community mental health team; DBT, dialectical behaviour therapy; f, female; GP, general practitioner; HSU, health service utilisation; IAPT, Improving Access to Psychological Therapies initiative; NC, NICE checklist for RCTs (score range=0–4; 0 indicates bias and 4 indicates no bias) (NICE, 2009); NHS, National Health Service; PD, personality disorder; ST, STROBE statement (score range 0–22; 0 represents lowest quality and 22 represents highest quality) (14); PCT=psychotherapy.